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ROLE OF WHO AND UNICEF IN HEALTH CARE DELIVERY SYSTEM IN INDIA

Presenter:Dr.S.PreethiGuide: Dr. Abhay S Nirgude Dr.Shivalli

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CONTENTS OF PRESENTATION

History

Present health care system

WHO

Current Mou of Rajasthan with WHO India

Unicef

Take home message

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HISTORY

Planned cities- drainage, public baths- Harappa

Spread of medical education – post Vedic period

Establishment of hospitals- Buddhist kings

British rule- Intro of various acts

- Establishment of various bureaus

Health survey and Development Committee (Bhore)

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HEALTH SYSTEM IN INDIA

Central , State and Local or peripheral

Central Ministry of health and family welfare Directorate general of health services The central council of Health and Family Welfare

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STATE LEVEL

Federal, Concurrent and state

Medical care, preventive health services

Provision of control of milk and food sanitation

Prevention of any outbreak and communicable disease

Promotion of health education & health programmes

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STATE LEVEL CONT………..

Supervision of PHC

Establishing training courses for health personnel

Co-Ordination of activities with other ministry of state such as

voluntary agency, minister of education and central health

minister.

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DISTRICT LEVEL

There are 593 districts and 6 types of admin

Sub divisions, taluks-(Tahsildars- 200-600 villages)

CDB-(100 villages, 80,000-1,20,000 population)

Municipality and corporation, villages and panchayath

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URBAN

Urban areas- town area committees(sanitary services)

municipal boards and corporation

Town area committees- 5,000-10,000 Municipal Boards- 10,000- 2 lac Corporation > 2 lac

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MUNICIPAL BOARD

Construction and maintenance of roads

Sanitation and drainage

Street lighting & water supply

Maintenance of hospitals and dispensaries

Education

Registration of births and deaths

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PANCHAYATH RAJ

Three tier system rural local self govt (village-district)

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HEALTH CARE DELIVERY SYSTEM

1. Government run health services

2. Private health sector

3. Industrial-organization-corporate sector, ESI

4. CGHS , Voluntary health organizations

5. Railway health services

6. AFMC & Indian System of medicine

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THREE TIER SYSTEM

Level Type of facility PopulationPrimary level •Sub centre( ANM/MPW)

•Primary health centre(MO)

•3,000- 5,000•20,000- 30,000

Secondary level •Community health centre(CHC)•District hospitals(DH)

80,000-1,20,000 or entire district

Tertiary level •Specialist hospitals•Regional/Central institutes/ Teaching Hospitals

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HEALTH CARE SYSTEM

At Village level-

VHG, Local Dais, Anganwadi workers, ASHA

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VILLAGE HEALTH GUIDES

Second Oct, 1977

Provide treatment of common minor ailments

First aid during accidents and emergency

MCH care

Family Planning

Health Education

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LOCAL DAIS

Training 30 working days- Rs 300 stipend

MCH care

FP and Immunization

Education about health service

Safe water and basic sanitation

Nutrition

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ANGANWADI WORKER

ICDS- 1000 population , training-4 month /Rs200-250

MCH care, FP & Immunization

Education about health

Referral services

Safe water and basic sanitation

Supplementary nutrition and non formal education

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ASHA/USHA

One ASHA- 1000 population

Women resident village- married/divorced/widow 25-45yrs

Formal education – 8th class

Create awareness on determinants of health

Birth preparedness/ safe delivery/BF/ immunization/ RTI

Mobilize (village/sub-centre/PHC)- ANC,PNC, ICDS

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IPH STANDARDS

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CHC

Block public health unit- BDO, Public health specialist and public

health nurse

Specialty services- Surgeon, physician, OBG, Pediatrician and

anesthetist

General duty medical officer, AYSH, Dental surgeon

Staff Nurse, Pharmacist

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WHO

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WHO-INDIA PROGRAMME OF WORK- GOI

Providing technical support developing NHP

Advocating UHC

Adopting evidence based public health interventions

Promote equity and accelerate movement UHC

WHO ( values, Functions)- equity, solidarity, participation

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WHO- OBSERVATIONS

World Health Report 2006 - countries (<23/10,000) fail to achieve

adequate coverage rates

target of at least 5% of GDP for health by 2000

WHO estimates that a minimum US$ 44 per person per year needs

to be spent to provide everyone access to a set of essential health

services.

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GLOBAL HEALTH AGENDA (2006-15) WHO'S ELEVENTH GENERAL PROGRAMME

(i) Investing in health to reduce poverty;

(ii) Building individual and global health security;

(iii) Promoting universal coverage

(iv) Tackling determinants of health;

(v) Strengthening health systems and equitable access;

(vi) Strengthening governance, leadership and accountability

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MISSION -WHO COUNTRY OFFICE FOR INDIA:

(i) Developing and sustaining its own health policies, health

systems and public health programmes;

(ii) Working to prevent and overcome threats to health;

(iii) Anticipating future challenges;

(iv) Advocating public health.

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TECHNICAL OFFICER-PRIMARY HEALTH CARE WHO-INDIA

Facilitating- implementation-work plans

Promote support evidence on primary health care services

Adaptation country context strategies, guidelines, SOPs

Monitoring evaluation policies, strategies & interventions

Intersectoral co-ordination

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CONT……….

Advise on matters regarding primary health care development,

financing and management

Technically review contractual proposals,

Support information brokering/exchange function of WCO India

Prepare administrative and technical reports

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EXAMPLE Polio cases (559 in 2008 to no case in 2012)

The Government, in partnership

UNICEF, WHO, the Bill & Melinda Gates Foundation

Rotary International & Centers for Disease Control & Prevention

Contributed to almost universal awareness

Vaccinate all children under five against polio

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WHO-GOAL HEATH FOR ALL

Universal coverage reforms

Service delivery reforms

Public policy reforms

Leadership reforms

Increasing stakeholder participation

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RAJASTHAN- CURRENT /MOU – WHO INDIA

Long-term technical collaboration accelerate progress towards UHC

Memorandum of Understanding (MoU) on 5 May 2015 at Jaipur,

WHO India provide broad technical support state

Designing innovative health financing mechanisms,

Improving quality of care and

Building on best practices and lessons state’s free medicines scheme.

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UNICEF- ACHIEVEMENTS

WHO Child Growth Standards - NRHM and ICDS

Operational Guidelines- SAM Malnutrition (MoHFW)

Nutrition Guidelines HIV-Exposed , Infected Children NACO-

prevent parent-to-child transmission of HIV and the launch of early infant diagnosis.

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UNICEF ACHIEVEMENTS CONT………..

(MWCD) launched nationwide Communication Campaign

Maternal and Child Nutrition in November 2012, jointly with Mr.

Aamir Khan,(UNICEF Ambassador - nutrition for children)

Largest public service campaigns country -people across India

Diverse means of communication 18 languages;

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UNICEF- ACHIEVEMENTS- CONT………..

Rural sanitation coverage (toilet construction) 48 % 2008 - 67 % 2010

Significant shift in the Nirmal Bharat Abhiyan (NBA) guidelines to

focus on sustained use of sanitation facilities.

Nirmal Gram Puraskar -increase of 19.7 million new toilet-users

Sarva Shiksha Abhiyan (SSA) gross completion rates (90 per cent in

2007-2008 to 102 per cent in 2010-2011)

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UNICEF ACHIEVEMENTS CONT……….

UNICEF helped the National Disaster Management

Post Disaster Reconstruction Guidelines

National Norms and Standards that set guide lines

For services like medical coverage and psychosocial care in relief

camps

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PROGRAMMES- PROPOSED FUNDING

The Child Development and Nutrition programme -national policies

and programmes -IYFP

RCH programme -ICDS (Village Health & Nutrition Days

WASH programme – Norms and Standards for Anganwadi Centres

Education programme support early childhood education

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CONT………..

PPE programme - ICDS - crèches and day care

Support to districts made from the states

Emerging issue -attention - support to children disabilities

UNICEF -identify strategic areas -play the role -“knowledge

broker” -children, adolescents and women

Thematic funded programme

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TAKE HOME MESSAGE

Health care “WHENEERS” W- Water H- Health E- Education N- Nutrition E- Economic E-

Environment R- Recreation S- Security

Needs satisfied with 3-tier system PHC- village level CHC- District level THC- Health institutions

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REFERENCES Bhalwar R. Text Book of Public Health and Community

Medicine. 1st ed. Pune: Dept of Community Medicine, AFMC. 2009.

Park.K. Text Book of Preventive and Social Medicine.22nd ed. Jabalpur: M/S. Banarasidas Bhonot Publishers;2013.

Measuring core health indicators in the SEARO 2014. Available on :http://www.who.int/healthsystems/topics/delivery/en.

Last retrieved on 12th June 2015.

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